Are clinicians responsible for clients’ self-inflicted injuries?

By
Marc W. Pearce, JD, PhD, University of Nebraska–Lincoln

July/August 2013, Vol 44, No. 7

Print version: page 26

M. Reeves had a history of mental illness dating to 2001, and in August 2005 she attempted suicide. This led to Reeves's involuntary commitment to a regional hospital. Within approximately one week, her commitment status was changed from involuntary to voluntary, and she was moved to a group home. She was then discharged at her own request on Aug. 17. On Aug. 23, Reeves was voluntarily re-admitted to the group home "because of clinical instability and danger of suicide." Three days later, she was visited by psychiatrist Mark Peterson, MD, who had been treating Reeves since December 2001. Peterson diagnosed severe major depressive disorder with psychosis and bipolar disorder with psychosis, and he prescribed medication.

On Aug. 29, Reeves was discharged from the group home for unspecified reasons. Then on Aug. 31, she doused herself with gasoline and set herself on fire.

Reeves sued Peterson, alleging that he was legally responsible for the injuries she suffered during her suicide attempt. Peterson argued that the case should not proceed to trial because he had no duty to involuntarily commit Reeves; he had no control over Reeves when she injured herself; and his acts or omissions were not the legal cause (i.e., "proximate cause") of Reeves' injuries. The trial court rejected Peterson's arguments, but the Georgia Court of Appeals agreed to consider them before allowing the case to go forward. In a splintered decision (the seven judges issued four different opinions), the court of appeals concluded that Reeves's lawsuit should be resolved by a jury (Peterson v. Reeves, March 30, 2012).

Two of the appellate judges concluded that under some circumstances, a failure to involuntarily commit a suicidal patient could constitute a breach of a physician's duty of care to the patient. Two other judges wrote a separate opinion to clarify that in their view, mental health professionals did not have "an affirmative duty" to involuntarily commit a potentially suicidal patient. All four of these judges agreed, however, that a trial was warranted because there was evidence showing that Reeves was at a high risk for suicide when she was discharged on Aug. 29; that Peterson breached his duty of care by failing to perform a proper suicide-risk assessment, failing to stabilize Reeves in a proper medication regimen, and failing to be available for consultation (or to arrange for another psychiatrist to be available for consultation) on the day of Reeves's discharge; and that Reeves's suicide attempt was a reasonably foreseeable consequence of Peterson's negligence. These four judges also rejected Peterson's argument that he was not responsible for Reeves's injuries because he lacked physical control over her when she attempted suicide.

Two other judges wrote two separate dissenting opinions noting that in Georgia, physicians had never before been held liable for failing to involuntarily commit someone, nor had they ever been held liable for failing to prevent a suicide when the patient was not under the physician's control. They also emphasized that Peterson was not consulted about Reeves' discharge; that Peterson's last visit with Reeves was too far removed from her suicide attempt to constitute a proximate cause; and that none of Reeves's expert witnesses was willing to state that Peterson's failure to involuntarily commit Reeves on Aug. 26 fell "below the standard of care." The dissenters also noted that a legal duty to involuntarily commit potentially suicidal patients could expose physicians to liability for false imprisonment.

Last January, the Georgia Supreme Court declined to consider Reeves's case — which means that the court of appeals's decision stands, and presumably the case will proceed to a trial or settlement. It is important to note that the decision is based on general principles of negligence law that could apply not only to psychiatrists, but also to psychologists. Thus, although the law of negligence varies somewhat from state to state, it would be wise for clinicians in all states to investigate whether their treatment of potentially suicidal clients could expose them to legal liability.

“Judicial Notebook” is a project of APA Div. 9 (Society for the Psychological Study of Social Issues).